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The National Health Service (General Medical Services) (Scotland) Regulations 1995

Type Statutory-Instrument

Publication 1995-02-21

State In force

Department Queen's Printer of Acts of Parliament

Source legislation.gov.uk

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(1) A person who is residing temporarily in a district and whose name is not on the list of a doctor providing general medical services in that district may, if he requires treatment, apply to any doctor to be accepted by him as a temporary resident and if he is so accepted his name shall not be removed from the list of any doctor in which it is already included.

(2) For the purpose of this regulation a person shall be regarded as temporarily resident in a district if when he arrives in that district he intends to stay there for more than 24 hours but not more than 90 days.

(3) If the stay of a person accepted under this regulation as a temporary resident in a district exceeds 90 days, he shall cease to be regarded as a temporary resident.

Doctors' lists

27

(1) A Board shall prepare and keep revised up to date in respect of each doctor on its medical list, a list of the patients in its area for whom each doctor is for the time being responsible and shall from time to time furnish the doctor with information concerning persons added to or deleted from the list.

(2) Subject to the provisions of regulation 22(4), the name of a person accepted by a doctor for inclusion in his list shall be included in the list from the date on which notification of acceptance is received by the Board.

(3) Where a person for whose treatment a doctor is responsible—

(a) dies, or

(b) is absent from the United Kingdom for a period of 90 days, or

(d) enlists in Her Majesty’s Forces, or

(e) is serving a prison sentence or sentences totalling in the aggregate more than two years,

his name shall be deleted from the doctor’s list as from the date on which the Board first received notification of the death, absence, departure, enlistment or imprisonment.

(4) Any deletion from a doctor’s list caused by the transfer of a person to the list of another doctor, otherwise than in accordance with a notice given under regulation 22(3) and (4), shall take effect from the date on which the Board receives notification of the acceptance of the person by the last-mentioned doctor or, subject to the consent of the Board, on such date, not being earlier than the date of such consent as may be agreed between the doctors.

(5) Where a doctor has requested the Board to remove a person from his list in accordance with paragraph 9(1) of the terms of service, the removal shall take effect from the date mentioned in that paragraph.

(6) Where a doctor has notified the Board that he wishes to have a person removed from his list with immediate effect in accordance with paragraph 9(2) of the terms of service—

(a) the removal shall take effect at the time mentioned in sub-paragraph (4) of that paragraph, and

(b) on receipt of the notification the Board shall—

(i) in writing, acknowledge it and also give notice of the removal to the person concerned, and

(ii) take all reasonable steps to assign the person to another doctor before the end of the next working day, or as soon as possible thereafter, and regulation 20 shall apply to such an assignment as if the person had applied for an assignment in accordance with that regulation.

(7) Any other deletion from a doctor’s list shall take effect as from the date on which notice of deletion is sent by the Board to the doctor or from such other date, not being earlier than that date, as may be specified in the notice.

PART V — child health surveillance services, contraceptive services, maternity medical services and minor surgery services

Child health surveillance list

28

(1) The Board shall maintain a list, in these Regulations referred to as “the child health surveillance list”, of the names of those doctors who have satisfied the Board or, on appeal, the Secretary of State in accordance with the following provisions of this regulation, that they have such medical experience and training as are necessary to enable them properly to provide child health surveillance services.

(2) A doctor may apply, in accordance with paragraph (3), to a Board for inclusion of his name in the child health surveillance list required to be maintained by that Board.

(3) An application under paragraph (2) shall be in writing, signed by the applicant and shall include the information specified in Part IV of Schedule 2.

(4) A doctor whose name is included in the child health surveillance list of any Board and who applies to have his name included in the corresponding list of another Board shall provide the information specified in paragraph (3) together with the name of the Board in whose such list his name is included and the date from which it was so included.

(5) The provisions of paragraphs (6) to (11) of this regulation shall not apply to any application by a doctor referred to in paragraph (4), and such application shall be granted by the Board and within 30 days after receiving the application the Board shall give written notice to the doctor to that effect.

(6) Unless the applicant otherwise agrees, the Board shall decide any application made in accordance with paragraph (3) by either granting or refusing it not later than the expiry of the period of 60 days after receiving it.

(7) The Board may, if it thinks fit, hold an oral hearing of any application and, if minded to refuse an application, shall not do so without first giving the doctor the opportunity of an oral hearing.

(8) The Board before deciding upon an application under this regulation, shall have regard in particular to—

(a) any training undertaken by the doctor; and

(b) any medical experience gained by him,

during the period of five years immediately preceding the date of the application which is relevant to the provision of child health surveillance services and in the case of any application shall seek and take into account the advice of any medical practitioners, including the Area Medical Committee, as it considers necessary to enable it to decide upon the application.

(9) Within 30 days of reaching its decision, the Board shall give written notice thereof to the applicant and shall—

(a) where it refuses the application give written notice of the reasons for the decision and of the right of appeal of the applicant under paragraph (10); or

(b) where it grants the application, include the applicant’s name in the child health surveillance list.

(10) Where an application is refused the applicant may appeal in writing to the Secretary of State within 30 days of receiving written notice of the Board’s decision.

(11) Where the applicant appeals under paragraph (10), the Secretary of State—

(a) may, if he thinks fit, hold an oral hearing of the appeal;

(b) in deciding upon the appeal, shall either confirm or reverse the decision of the Board;

(c) where he reverses the decision of the Board, shall direct that the Board include the doctor’s name in its child health surveillance list.

(12) Subject to paragraphs (13) to (17) the Board may remove a doctor’s name from the child health surveillance list only in the following circumstances:—

(a) if it has been removed from the medical list of any Board under regulation 7 or 8; or

(b) if the Board is satisfied that the doctor has not provided child health surveillance services during the immediately preceding 5 years; or

(c) if the Board is satisfied that the doctor has, in relation to any patient in respect of whom he has undertaken to provide child health surveillance services failed in any material respect to comply with any of the requirements of regulation 29(4) and Schedule 3; or

(d) if the Board is satisfied that the doctor is no longer able to provide child health surveillance services.

(13) Before reaching any decision in terms of sub-paragraphs (b), (c) or (d) of paragraph (12) the Board shall—

(a) give the doctor 30 days' notice in writing of its intention to do so, and

(b) afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the Board.

(14) Where the Board reaches a decision in terms of any of sub-paragraphs (b), (c) or (d) of paragraph (12), it shall send to the doctor a notice which shall include a statement—

(a) to the effect that, subject to any appeal under paragraph (15), the doctor’s name will, after 30 days from the date of notice, be removed from the child health surveillance list maintained by the Board;

(b) of the Board’s reasons for its decision; and

(15) A doctor who has received a notice sent in accordance with paragraph (14) may, within 21 days of receiving it, appeal to the Secretary of State against the decision of the Board, and pending the determination of the appeal the Board shall not remove his name from the child health surveillance list.

(16) An appeal to the Secretary of State shall be made in writing and shall include a statement of the facts and contentions on which the doctor intends to rely; and, if he allows the appeal, the Secretary of State shall direct that the Board does not remove the doctor’s name from the child health surveillance list.

(17) The Board shall comply with any direction given under this regulation.

Obtaining child health surveillance services

29

(1) The appropriate person, in relation to a child who is under the age of 5 years, may apply to a doctor—

(a) who is—

(i) the doctor on whose list the child is included (in this paragraph referred to as “the child’s doctor”),

(ii) a doctor with whom the child’s doctor practises in partnership, or

(iii) a doctor with whom the child’s doctor is associated in a group practice; and

(b) whose name is included in any medical list and in the child health surveillance list of the Board,

for the provision of child health surveillance services in respect of the child for a period ending on the date on which the child attains the age of 5 years.

(2) In paragraph (1) the “appropriate person” in relation to a child who is under the age of 5 years is a person who has the right under regulation 39 to choose on behalf of the child the person by whom general medical services are to be provided for the child.

(3) A doctor whose name is included in the medical list may, in respect of any person on his list or on the list of a doctor with whom he practices in partnership or with whom he is associated in a group practice, undertake to provide child health surveillance services provided that—

(a) his name is also included in the child health surveillance list, and

(b) the person in question is a child who is under the age of 5 years.

(4) A doctor who has undertaken, pursuant to paragraph (3), to provide child health surveillance services to any child shall, in respect of that child—

(a) provide all the services described in paragraph 1 of Schedule 3, until the date upon which the child attains the age of 5 years, other than any examination so described which the appropriate person refuses to allow the child to undergo;

(b) maintain such records as are specified in paragraph 2 of that Schedule; and

(c) provide to the Board in accordance with the requirements of paragraph 3 of that Schedule such information as is specified in that paragraph.

(5) An undertaking to provide child health surveillance services shall cease forthwith to be effective if—

(a) either—

(i) the appropriate person informs the doctor, or

(ii) the doctor informs the appropriate person,

Contraceptive services

30

(1) Where a woman (including a woman who is a temporary resident within the meaning of regulation 26) desires contraceptive services she may apply to any doctor who had indicated his willingness to provide such services to be accepted by him for the provision to her of contraceptive services.

(2) Subject to the provisions of paragraph (3), where a woman is accepted by the doctor he shall be responsible for the provision of contraceptive services to her for a period of 1 year, except in the case of a temporary resident within the meaning of regulation 26, when the responsibility shall be limited to the period of temporary residence.

(3) Either the woman or the doctor may terminate the arrangement for the provision of contraceptive services at any time during the period of 1 year by giving 30 days' notice to the other party to the arrangement and to the Board.

(4) On the expiry or termination of the arrangement the woman may apply or reapply to a doctor to be accepted by him for the provision to her of contraceptive services and the provisions of this regulation shall apply to such further application.

Obtaining maternity medical services

31

(1) A woman who, after a doctor has diagnosed that she is pregnant, desires the provision of maternity medical services, may arrange for the provision of such services either by any doctor on a medical list who has indicated his willingness to provide maternity medical services, or by the doctor in whose list her name is included.

(2) A woman who has arranged with a doctor (in this paragraph and paragraph (3) referred to as “the original doctor”) for the provision of maternity medical services may terminate the arrangement by—

(a) giving written notice to that effect to—

(i) the Board; or

(ii) the original doctor who shall within 7 days give written notice to the Board; or

(b) making a new arrangement with another doctor who shall within 7 days give written notice to the Board of the new arrangement.

(3) Where a Board receives notification in accordance with paragraph (2)(a)(i) or (b) it shall within 7 days give written notice to the original doctor that the arrangement with him has been terminated.

(4) A woman who is residing temporarily in any district may arrange with a doctor for the provision by him of maternity medical services during her period of temporary residence without prejudice to her right to obtain such services in any other area in which she may become resident.

Minor surgery list

32

(1) The Board shall maintain a list, in these Regulations referred to as “the minor surgery list”, of the names of those doctors who have satisfied the Board or, on appeal, the Secretary of State in accordance with the following provisions of this regulation, that they have such experience, training and qualifications as are necessary to enable them properly to provide all of the procedures listed in Schedule 4.

(2) A doctor may apply, in accordance with paragraph (3), to a Board for inclusion of his name in the minor surgery list required to be maintained by that Board.

(3) An application under paragraph (2) shall be in writing, signed by the applicant and shall include the information specified in Part V of Schedule 2.

(4) A doctor whose name is included in the minor surgery list of any Board and who applies to have his name included in the corresponding list of another Board shall provide the information specified in paragraph (3) together with the name of the Board in whose such list his name is included and the date from which it was so included.

(5) The provisions of paragraphs (6) to (11) of this regulation shall not apply to any application by a doctor referred to in paragraph (4), and such application shall be granted by the Board and within 30 days after receiving the application the Board shall give written notice to the doctor to that effect.

(6) Unless the applicant otherwise agrees, the Board shall decide any application made in accordance with paragraph (3) by either granting or refusing it not later than the expiry of the period of 60 days after receiving it.

(7) The Board may, if it thinks fit, hold an oral hearing of any application and, if minded to refuse an application, shall not do so without first giving the doctor the opportunity of an oral hearing.

(8) The Board before deciding upon an application under this regulation shall have regard in particular for the purpose of assessing the doctor’s medical experience to any—

(a) postgraduate qualification held by him;

(b) training undertaken by him;

during the period of five years immediately preceding the date of the application which is relevant to the provision of minor surgery services, and in the case of any application shall seek and take into account the advice of any medical practitioners, including the Area Medical Committee, as it considers necessary to enable it to decide upon the application.

(9) Within 30 days of reaching its decision, the Board shall give written notice thereof to the applicant and shall—

(a) where it refuses the application give written notice of the reasons for the decision and of the right of appeal of the applicant under paragraph (10); or

(b) where it grants the application, include the applicant’s name in the minor surgery list.

(10) Where an application is refused the applicant may appeal in writing to the Secretary of State within 30 days of receiving written notice of the Board’s decision.

(11) Where the applicant appeals under paragraph (10), the Secretary of State—

(a) may, if he thinks fit, hold an oral hearing of the appeal;

(b) in deciding upon the appeal, shall either confirm or reverse the decision of the Board;

(c) where he reverses the decision of the Board, shall direct that the Board include the doctor’s name in its minor surgery list.

(12) Subject to paragraphs (13) to (17) the Board may remove a doctor’s name from the minor surgery list only in the following circumstances:—

(a) if it has been removed from the medical list of any Board under regulation 7 or 8; or

(b) if the Board is satisfied that the doctor has not provided minor surgery services during the immediately preceding 5 years; or

(c) if the Board is satisfied that the doctor has, in relation to any patient in respect of whom he has undertaken to provide minor surgery services failed in any material respect to comply with any of the requirements of regulation 33 and Schedule 4; or

(d) if the Board is satisfied that the doctor is no longer able to provide minor surgery services.

(13) Before reaching any decision in terms of sub-paragraphs (b), (c) or (d) of paragraph (12) the Board shall—

(a) give the doctor 30 days' notice in writing of its intention to do so, and

(b) afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the Board.

(14) Where the Board reaches a decision in terms of any of sub-paragraphs (b), (c) or (d) of paragraph (12), it shall send to the doctor a notice which shall include a statement—

(a) to the effect that, subject to any appeal under paragraph (15), the doctor’s name will, after 30 days from the date of notice, be removed from the minor surgery list maintained by the Board;

(b) of the Board’s reasons for its decision; and

(15) A doctor who has received a notice sent in accordance with paragraph (14) may, within 21 days of receiving it, appeal to the Secretary of State against the decision of the Board, and pending the determination of the appeal the Board shall not remove his name from the minor surgery list.

(16) An appeal to the Secretary of State shall be made in writing and shall include a statement of the facts and contentions on which the doctor intends to rely; and, if he allows the appeal, the Secretary of State shall direct that the Board does not remove the doctor’s name from the minor surgery list.

(17) The Board shall comply with any direction given under this regulation.

Obtaining minor surgery services

33

(1) A person may apply to a doctor—

(a) who is—

(i) the doctor on whose list he is included (in this paragraph referred to as “his own doctor”),

(ii) a doctor with whom his own doctor practises in partnership, or

(iii) a doctor with whom his own doctor is associated in a group practice; and

(b) whose name is included in any medical list and in the minor surgery list of the Board,

for the provision of any procedure specified in Schedule 4.

(2) A doctor whose name is included in the medical list may, in respect of any person on his list or on the list of a doctor with whom he practises in partnership or with whom he is associated in a group practice, undertake to provide minor surgery services, provided that his name is included in the minor surgery list.

(3) A doctor who has undertaken, pursuant to paragraph (2), to provide minor surgery services in respect of any patient shall provide, or at least offer to provide, any of the procedures described in Schedule 4 which it is, in his opinion, appropriate for him to provide in respect of that patient.

(4) Where a doctor provides minor surgery services in respect of a patient who is not included on his list, he shall inform in writing the doctor on whose list the patient is included of the outcome of the procedure.

(5) A doctor who provides minor surgery services shall ensure that at all times he has available suitable and adequate premises, equipment and facilities for use by him in providing such services.

(6) A doctor shall not be required to provide minor surgery services for a patient unless, following an application pursuant to paragraph (1), he has accepted that patient for the provision of such services.

(7) Nothing in this regulation shall prevent any doctor personally performing, in the course of providing general medical services (otherwise than by way of minor surgery services) for the benefit of a patient, a procedure described in Schedule 4.

PART VI — supply of drugs etc., by doctors

Arrangements for supply by doctors of drugs and appliances

34

(1) Where the Board after consultation with the Area Pharmaceutical Committee is satisfied that a person, by reason of distance or inadequacy of means of communication or other exceptional circumstances, will have serious difficulty in obtaining from a pharmacist any drugs, not being scheduled drugs, or appliances required for his treatment under these Regulations, the Board shall require the doctor who is responsible for the treatment of the person to supply such drugs and appliances to that person until further notice.

(2) Notwithstanding anything contained in this regulation—

(a) a doctor shall not be required to undertake the supply of drugs and appliances under this regulation if he satisfies the Board, or, on appeal, the Secretary of State, that he is not in the habit of dispensing drugs for his patients; and

(b) a doctor shall be entitled to receive reasonable notice from the Board that he is required to undertake the supply of drugs and appliances under this regulation or that such supply is to be discontinued.

PART VII — payments to doctors

Payments

35

(1) For each financial year ending on 31st March a Board shall make payments to doctors with whom arrangements exist for the provision of general medical services in its area in accordance with such rates and subject to such conditions as the Secretary of State in a Statement may determine after such consultation with such organisations as he may recognise as representing doctors with whom arrangements exist for the provision of general medical services. The Statement shall make provision for the following matters:—

(a) basic practice allowance, and additional allowances for designated areas, seniority and employment of assistants;

(b) standard capitation fees, capitation fees for elderly patients, and fees for night visits;

(d) fees and allowances for the supply of drugs and appliances and for rural practice, fees for contraceptive services and fees for maternity medical services;

(e) allowances for training doctors and for initial practice or inducement to practise;

(f) allowances for practice expenses and for improvement of premises;

(g) payments in relation to the making of arrangements for, and payments for, the temporary provision of general medical services;

(h) capitation fees in respect of patients who participate in a consultation in accordance with paragraph 14 of Schedule 1;

(i) capitation fees in respect of patients to whom child health surveillance services are provided;

(j) capitation fees in respect of patients who are resident in deprived areas;

(k) a fee for each minor surgery session undertaken;

(l) payments in respect of health promotion programmes approved by the Board;

(m) payments in respect of disease management programmes approved by the Board;

(n) target payments in respect of immunisations provided;

(o) target payments in respect of cervical cytology;

(p) allowances for the employment of locums by doctors during confinement, sickness or study leave;

(q) allowances for undergoing approved postgraduate education;

(r) allowances for the employment of doctors by isolated single-handed doctors;

(s) allowances in respect of providing placements in practices for undergraduate medical students;

(t) transitional payments in consequence of changes to the terms of service;

and may be amended from time to time by the Secretary of State after consultation with such organisations as aforesaid.

(2) Where a doctor is on the medical list of more than one Board any payment due to the doctor may, where the Statement so provides, be made by one Board on behalf of all Boards concerned.

Claims and overpayments

36

(1) Any claim for fees, allowances or other remuneration by doctors shall be made in accordance with the provisions of the Statement under regulation 35.

(2) Where the Board considers that a payment has been made in circumstances when it was not due, the Board, except to the extent that the Secretary of State on the application of the Board directs otherwise, shall draw the overpayment to the attention of the doctor and—

(a) where the overpayment is admitted by him; or

(b) where the overpayment is not so admitted but, the matter having been referred under regulation 8(1) of the National Health Service (Service Committees and Tribunal) (Scotland) Regulations 1992[^f00017] for investigation, the Board, or the Secretary of State on appeal under regulation 12 of those Regulations, decides that there has been an overpayment,

the amount overpaid shall be recoverable either by deduction from the doctor’s remuneration or in some other manner.

(3) Recovery of an overpayment under this regulation shall be without prejudice to the investigation of an alleged breach of the terms of service.

PART VIII — miscellaneous

Publication of particulars

37

(1) A Board shall make available for inspection at its office copies of—

(a) the medical list,

(b) the terms of service,

(d) the Local Directory,

(e) a compendium of practice leaflets provided to it by doctors whose names are included in its medical list,

and shall keep them up-to-date.

(2) A Board may make any of the documents described in paragraph (1) available for inspection at such other places in its area as appear convenient for informing all persons interested, or may publish at such places a notice of the places and times at which copies of any of those documents may be inspected; provided always that in the case of the medical list that document may be made available for inspection without the names of the doctors who would otherwise be listed there only temporarily by virtue of appointment under regulation 24, or who do not provide general medical services in the locality of that other place.

(3) The Board shall—

(a) send a copy of the medical list to the Secretary of State, the Medical Practices Committee, the Area Medical and Pharmaceutical Committees and to all pharmacists providing pharmaceutical services in the area; and

(b) at intervals of not more than 90 days notify them of any alterations.

(4) Notwithstanding paragraph (3), if the Board considers that only parts of the medical list, or that only some alterations, are likely to concern any such persons or bodies, it may send to those persons or bodies a copy of only those parts or alterations.

Guidance to doctors

38

(1) Subject to paragraph (2) a Board may issue guidance to doctors whose names are included in its medical list to assist them in assessing, in accordance with paragraph 22 of Schedule 1, the qualifications, experience and competence of any employee or prospective employee.

(2) Any guidance issued under paragraph (1) shall—

(a) be issued only after consultation with the Area Medical Committee, and

(b) have regard to standards adopted either by an appropriate national regulatory body for a profession or occupation or by a similar body.

Exercise of choice of doctor in certain cases

39

(1) The right to choose the person by whom general medical services under Part II of the Act are to be provided shall be exercised—

(a) subject to sub-paragraph (c) on behalf of any child by the mother, or in her absence, the father, or in the absence of both parents, the guardian or other person who has care of the child;

(b) on behalf of any other person who is incapable on account of sickness or other infirmity of choosing a person to provide such services, by a relative or any person who has the care of such person;

(c) on behalf of any person under the age of 18 in the care of a local authority under Part II of the Social Work (Scotland) Act 1968[^f00018] or under the relevant provisions of the said Part II as applied by section 44(5) of the said Act[^f00019], by a person duly authorised by that authority.

(2) The right of choice in paragraph (1) shall not be exercised by the person to whom the application for general medical services is made.

SCHEDULE 1 — TERMS OF SERVICE FOR DOCTORS

Interpretation

1

In this Schedule, unless the context otherwise requires—

(a) “associate” means a doctor employed by a single-handed isolated practitioner with the consent of the Board;

(b) “patient” means a person for whose treatment a doctor is responsible under paragraph 4 of these terms of service;

(c) “deputising service” means any person or body carrying on a business which consists of or includes the provision of deputies for periods which normally do not exceed 72 consecutive hours:

(d) “prescription form” means a form provided by the Board or, where the doctor is on the medical list of more than one Board, by the Board which is responsible for the supply of that form for issue by a doctor to enable a person to obtain pharmaceutical services as defined by section 27 of the Act[^f00020];

(e) unless the context otherwise requires any reference in a paragraph in this Schedule to a numbered sub-paragraph is a reference to the sub-paragraph bearing that number in that paragraph.

Incorporation of provisions of regulations, etc.

2

Any provisions of the following affecting the rights and obligations of doctors shall be deemed to form part of the terms of service:—

(a) these Regulations;

(b) any Statement made under regulation 35;

(c) any provisions of Part II of the National Health Service (Service Committees and Tribunal) (Scotland) Regulations 1992[^f00021].

Exercise of professional judgment

3

Where a decision whether any, and if so what, action is to be taken under these terms of service requires the exercise of professional judgment, a doctor shall not, in reaching that decision, be required to exercise a higher degree of skill, knowledge and care than—

(a) in the case of a doctor providing child health surveillance services under regulation 29 or minor surgery services under regulation 33, that which any general practitioner included in the child health surveillance list or, as the case may be, the minor surgery list might reasonably be expected to exercise; and

(b) in any other case, that which general practitioners as a class might reasonably be expected to exercise.

Persons for whose treatment the doctor is responsible

4

(1) The persons for whose treatment a doctor is responsible are—

(a) all persons whom he has accepted or agreed to accept for inclusion in his list and who have not been notified to him by the Board as having ceased to be on his list;

(b) all persons whom he has accepted or agreed to accept as temporary residents;

(c) all persons who have been assigned to him and who have not been notified to him by the Board as having ceased to be on his list;

(d) all persons for whom he may be required in terms of sub-paragraph (2) to provide treatment pending their acceptance by or assignment to a doctor;

(e) all persons for whom he may be required in terms of sub-paragraph (3) to provide treatment which is immediately required in case of accident or other emergency;

(f) all persons to whom the doctor is required to give necessary treatment under paragraph 10;

(g) all persons in respect of whom he is acting as a deputy under the provisions of paragraph 18(6);

(h) during the period of an appointment under regulation 24 persons whom he has been appointed to treat temporarily;

(i) in respect of contraceptive services and maternity medical services women for whom he has undertaken to provide such services;

(j) in respect of services specified in regulations 29 and 33 and paragraph 8, persons to whom he has undertaken to provide those services;

(k) during the hours agreed with the Board, any person whose own doctor has been relieved of responsibility during those hours specified in paragraph 5 and for whom he has accepted responsibility.

(2) If a doctor refuses to accept, for inclusion in his list or as a temporary resident, a person who lives in his practice area and who is not in the list of, or has not been accepted as a temporary resident by, another doctor practising in that area, he may inform him of the name and address of any neighbouring doctor to whom he may apply for acceptance and shall inform him of the name and address of the Board and of his right to apply to it for assignment, and he shall give that person any treatment which he may require until that person has been accepted by or assigned to another doctor.

(3) Where a doctor has notified the Board that he wishes to have a person removed from his list in accordance with paragraph 9(2), he shall on request give that person any immediately necessary treatment until the expiry of 14 days beginning with the date of the notification or until that person has been accepted by or assigned to another doctor, whichever occurs first.

(4) If a doctor notifies the Board in writing of his refusal to accept for inclusion in his list or as a temporary resident, a person specified in sub-paragraph (2) and states the person’s name and address, the Board shall forthwith inform the person that he should at once apply to another doctor, or to the Board for assignment to a doctor and, if he has not been accepted by another doctor and has not applied for assignment before the expiry of 14 days after receipt of the Board’s communication, he shall be deemed to have applied to the Board for assignment and shall be assigned by the Board to a doctor in accordance with the provisions of regulation 20(1), and the obligation to give treatment in sub-paragraph (2) shall cease on the date of the assignment.

(5) If a doctor is requested to provide treatment, and is available, he shall provide treatment immediately required, by reason of accident or other emergency, by a person who is not on the list of and who has not been accepted as a temporary resident by or assigned to, any doctor practising in the locality, or who is on the list of or has been accepted as a temporary resident by or assigned to, such a doctor, but neither the said doctor nor any deputy whom he may have appointed is available.

(6) Notwithstanding anything contained in this paragraph, a doctor shall not be responsible under these terms of service for the treatment in hospital of a person admitted thereto for treatment by the staff of the hospital.

5

A doctor who is elderly or infirm or who has been exempted by the Board under regulation 20(2) from the liability to have persons assigned to him may be relieved by the Board of any liability for emergency calls arising between 7 pm on weekdays and 8 am on the following morning and between 1 pm on Saturday and 8 am on the following Monday to persons who—

(a) are not on his list, or

(b) are not temporary residents for whom he is responsible, or

Acceptance of patients

6

(1) A doctor may agree to accept a person on his list if the person is eligible to be accepted by him.

(2) A doctor shall indicate his acceptance of an applicant by signing either his medical card or a form of application for acceptance which has been completed by the applicant or on his behalf, and sending the card or form to the Board within 14 days of receiving it. Where any person is authorised by the doctor to sign the card or form on behalf of that doctor, he shall say so accordingly and in addition to his own signature, add the doctor’s name.

7

A doctor may—

(a) undertake to provide contraceptive services to a woman who has applied to him in accordance with regulation 30;

(b) accept as a temporary resident a person who has applied to him in accordance with regulation 26(1);

(c) undertake to provide maternity medical services to a woman who has made an arrangement with him in accordance with regulation 31(1).

8

Notwithstanding that the person concerned is not on his list, a doctor may—

(a) take a cervical smear from a woman who would be eligible for acceptance by him as a temporary resident or for whom he has undertaken to provide maternity medical services or contraceptive services;

(b) vaccinate or immunise a person who would be eligible for acceptance by him as a temporary resident.

Right of a doctor to have patient removed from his list

9

(1) Subject to sub-paragraphs (2) to (5), a doctor may have the name of any person removed from his list by giving notice to the Board and the removal shall take effect on the date of acceptance of that person by, or assignment to, another doctor or on the eighth day after the Board receives such notice, whichever first occurs. If the doctor at the date when removal would take effect is providing treatment to the person (otherwise than at intervals of more than 7 days because of the chronic nature of the person’s illness), the doctor shall notify the Board accordingly, and removal shall take place on the eighth day after the Board receives notice from him that the person no longer requires such treatment or upon acceptance by, or assignment to, another doctor, whichever first occurs.

(2) Where—

(a) a person on a doctor’s list has committed an act of violence against the doctor or has behaved in such a way that the doctor has feared for his safety; and

(b) the doctor has reported the incident to the police or the Procurator Fiscal

the doctor may notify the Board that he wishes to have that person removed from his list with immediate effect.

(3) Notification under sub-paragraph (2) may be given by any means including telephone or fax, but if not given in writing shall subsequently be confirmed in writing within 7 days (and for this purpose a faxed notification is not a written one).

(4) The time at which the doctor notifies the Board shall be the time at which he makes the telephone call or sends or delivers the notification to the Board.

(5) Where pursuant to this paragraph a doctor has notified the Board that he wishes to have a person’s name removed from his list with immediate effect, he shall take all reasonable steps to inform the person concerned.

Evidence of person’s title to obtain treatment

10

(1) A doctor is entitled to require a person claiming to be on his list and applying for treatment, regarding whose identity he has reasonable doubts, to produce his medical card.

(2) If such a person fails on request to produce his medical card, the doctor is required to give any necessary treatment (including the supply of any drugs or appliances which he would be required to supply to a person on his list) but the doctor may charge the applicant a reasonable fee for any treatment given, including any drugs or appliances supplied, provided that he renders the applicant an account, or gives him a receipt for the fee. The doctor may order any drugs or appliance required for the treatment of the applicant in the same way as for a person on his list.

(3) If the applicant applies to the Board within 14 days after receiving the account or paying the fee, as the case may be (or within such longer period not exceeding 30 days as may be allowed by the Board if it is satisfied that the failure to make application within the period of 14 days was occasioned by some reasonable cause) and the Board is satisfied that he was on the doctor’s list, the Board may require the doctor to withdraw his account, or if the fee has been paid, may recover the fee from the doctor by deduction from his remuneration or otherwise and repay it to the applicant. If the doctor has supplied any drug or appliance for which, in the case of a person on his list, he would have been entitled to payment from the Board, the Board shall credit him with the payment to which he would have been so entitled.

Services to patients

11

(1) Subject to paragraphs 3, 13 and 31 a doctor shall render to his patients all necessary and appropriate personal medical services of the type usually provided by general medical practitioners.

(2) The services which a doctor is required by sub-paragraph (1) to render shall include the following:—

(a) the administration of anaesthetics or the rendering of any other assistance at an operation performed by, and of the kind usually performed by, a general medical practitioner;

(b) where appropriate giving advice personally to patients, either individually or in groups, relating to their general health, and in particular on the significance of diet, exercise, the use of tobacco, the consumption of alcohol and the misuse of drugs and solvents;

(c) offering to patients consultations and, where appropriate, physical examinations for the purpose of identifying, or reducing the risk of, disease or injury;

(d) offering to patients, where appropriate, vaccination or immunisation against Measles, Mumps, Rubella, Pertussis, Poliomyelitis, Diphtheria and Tetanus;

(e) arranging for the referral of patients, as appropriate, for the provision of any other services provided under the Act;

(f) giving advice, as appropriate, to enable patients to avail themselves of social work services provided by a local authority.

(3) A doctor shall not be required under sub-paragraph (1) or (2) to provide to any person—

(a) services which involve the application of such special skill or experience of a degree or kind which general medical practitioners as a class cannot reasonably be expected to possess;

(b) the administration of an anaesthetic at an operation performed by a doctor in the course of providing maternity medical services;

(c) contraceptive services, child health surveillance services, minor surgery services nor, except in an emergency, maternity medical services, unless he has previously undertaken to provide such services to that person; or

(d) where he is a restricted services principal, any category of general medical services which he has not undertaken to provide.

(4) In the case of maternity medical services the expression “all necessary and appropriate personal medical services” includes the provision of all necessary medical services (other than services which involve the application of special skill or experience of a degree or kind which general medical practitioners as a class cannot reasonably be expected to possess) during and following pregnancy and labour in respect of all conditions arising therefrom and in particular the following services:—

(a) antenatal services, i.e. full antenatal care, supervision and examination, including full medical and obstetric examination of the patient as soon as possible after the doctor’s engagement to provide maternity medical services and such further examination as the condition of the patient requires;

(b) services during the confinement and lying-in period including—

(i) attendance at some stage of labour either before or at delivery, or at such early time thereafter as is reasonably possible in the light of clinical circumstances;

(ii) attendance within twelve hours of completion of labour or as soon thereafter as practicable and as often as the condition of the patient or her child requires throughout a lying-in period of 14 days;

(iii) attendance at any time when summoned by the midwife attending the case;

(c) post-puerperal services, i.e., medical and pelvic examination of the patient at or about six weeks after confinement.

(5) The doctor providing the maternity medical services shall, if he is not the doctor on whose list the name of the person is included—

(a) comply with any request by the doctor on whose list the name of the woman is included to examine or give other assistance to the woman and her child if and so far as the practitioner providing the services considers it necessary and appropriate that he should do so;

(b) issue, in accordance with the provisions of paragraph 13(7) to the woman or her personal representative certificates of pregnancy, expected confinement and confinement, being certificates reasonably required by her.

(6) The doctor providing the services shall also, subject always to paragraph 4(5) administer an anaesthetic or render other assistance, as required, in connection with any service or operation performed by another doctor otherwise than as part of the general medical services, if the administration of the anaesthetic or the rendering of such other assistance does not involve the application of special skill or experience of a degree or kind which general medical practitioners as a class cannot reasonably be expected to possess.

(7) Nothing in the foregoing shall affect the responsibility of the doctor on whose list the name of the woman receiving maternity medical services is included for the provision of treatment necessary for her general health.

(8) In the case of emergency, the doctor is required to render whatever services are, having regard to the circumstances, in the best interest of the patient.

(9) In determining whether a particular service involves the application of such special skill and experience as aforesaid, regard is to be had to the question whether services of the kind are or are not usually undertaken by general medical practitioners practising in the area in which the question arose.

Practice leaflet

12

(1) Subject to sub-paragraph (2), a doctor whose name is included in the medical list shall compile in relation to his practice a document (in this paragraph called a “practice leaflet”) which shall include the information specified in Schedule 5.

(2) Sub-paragraph (1) shall, in relation to a doctor referred to in regulation 4(5)(f), apply only to the extent that the Board sees fit.

(3) A doctor shall review his practice leaflet at least once in every period of 12 months and shall make any amendments necessary to maintain its accuracy.

(4) A doctor shall make available a copy of the most recent edition of his practice leaflet to the Board, to each patient on his list and to any other person who, in the doctor’s opinion, reasonably requires one.

(5) A doctor who practises in partnership with other doctors whose names are included in the medical list shall satisfy the requirements of this paragraph if he makes available a practice leaflet, compiled and, where appropriate, revised in accordance with sub-paragraphs (1) and (3) which relates to the partnership as a whole; and in such a case a doctor may, if he so wishes, also produce a practice leaflet relating to his own activities.

Treatment of patients

13

(1) If the condition of a patient is such that he requires treatment which is not within the scope of the doctor’s obligations under these terms of service, but such treatment is to the knowledge of the doctor available under the National Health Service, the doctor shall inform the patient of the fact and if the patient so wishes, the doctor shall take all necessary steps to enable him to receive such treatment. The doctor shall also give his patients such advice or assistance as he may consider appropriate to enable them to take advantage of other medical services available under the National Health Service.

(2) Subject to the following provisions of this paragraph, a doctor shall render the services referred to in paragraph 11 (in this paragraph called the “relevant services”) during the hours for which he is normally available pursuant to paragraph 24 (in this paragraph referred to as “normal hours”)—

(a) at his practice premises; or

(b) in the case of a patient whose condition is such that in the doctor’s reasonable opinion it would be inappropriate for the patient to attend at the practice premises, at whichever is appropriate of the places set out in sub-paragraph (5).

(3) Outside normal hours the doctor shall consider, in the light of the patient’s medical condition, whether a consultation is needed, and if so, when.

(4) If in the doctor’s reasonable opinion a consultation is needed before the next time at which the patient could be seen during normal hours, he shall render the relevant services—

(a) at his practice premises;

(b) at such other place as the Board has agreed, pursuant to paragraph 27 and he has informed the patient, pursuant to paragraph 27(5), is a place where he will treat patients outside normal hours; or

(c) in the case of a patient whose condition is such that in the doctor’s reasonable opinion it would be inappropriate for the patient to attend either at the practice premises or at such other place, at whichever is appropriate of the places set out in sub-paragraph (5).

(5) The places referred to in sub-paragraphs (2)(b) and (4)(c) are—

(a) the place where the patient was residing when he was accepted by the doctor pursuant to paragraph 6 or, as the case may be, when he was assigned to the doctor pursuant to regulation 20 or, in the case of a patient who was previously on the list of a doctor in a practice declared vacant, when the doctor succeeded to the vacancy;

(b) such other place as the doctor has informed the patient and the Board is the place where he has agreed to visit and treat the patient;

(6) Nothing in this paragraph prevents the doctor from—

(a) arranging for the referral of a patient pursuant to paragraph 11(2)(e) without first seeing the patient, in a case where the medical condition of the patient makes that course of action appropriate; or

(b) visiting the patient in circumstances where this paragraph does not place him under an obligation to do so.

(7) A doctor shall issue to a patient or his personal representatives free of charge any certificate of a description prescribed in the first column of Schedule 9 which is reasonably required by him under or for the purposes of the enactments specified in the second column of the said Schedule opposite and in relation to the description of the certificate in the first column. Any certificate issued under this sub-paragraph for the purposes of:

(a) the Social Security Act 1975[^f00022]; or

(b) section 17(2) of the Social Security and Housing Benefits Act 1982[^f00023]; or

shall be issued in accordance with any regulations made under those Acts.

(8) A doctor shall not be required to issue a certificate under this paragraph where the patient is receiving treatment otherwise than from or under the supervision of a doctor.

(9) A doctor, except when providing maternity medical services, is responsible for providing the services of another doctor for the administration of an anaesthetic, when necessary, in connection with any service or operation on his patient undertaken by him under these terms of service whenever such administration does not involve the application of special skill or experience of a degree or kind which general medical practitioners as a class cannot reasonably be expected to possess.

(10) A doctor providing maternity medical services is responsible for providing the services of another doctor for the administration of an anaesthetic when necessary in connection with any operation performed by him on his patient and undertaken by him under these terms of service.

(11) The provisions of sub-paragraphs (2) and (3) shall not apply in the case of a patient who attends when an appointment system is in operation and who has not previously made, and is not given, an appointment. In such a case the doctor may decline to attend the patient during that surgery period, if the patient’s health would not thereby be jeopardised and the patient is offered an appointment to attend within a reasonable time having regard to all circumstances. The doctor shall take all reasonable steps to ensure that a consultation is not so deferred except in accordance with his instructions.

Newly registered patients

14

(1) Subject to sub-paragraphs (4) to (9), where a patient has been accepted on the list of a doctor under paragraph 6 or assigned to such a list under regulation 20, the doctor shall, in addition and without prejudice to his other obligations in respect of that patient under these terms of service, within 30 days of the date of such acceptance or assignment, invite the patient to participate in a consultation either at his practice premises or, if the condition of the patient so warrants, at such other place as the doctor is obliged, under paragraph 13(4)(b), to render personal medical services to that patient.

(2) Where a patient (or, in the case of a patient who is a child, the appropriate person in relation to that child) agrees that he, or in the case of a child, that the child will participate in such a consultation as is mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) seek details as to the medical history of the patient and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i) illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer,

(ii) social factors (including employment or unemployment, housing and family circumstances) which may affect his health,

(iii) factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol, and misuse of drugs or solvents) which may affect his health, and

(iv) the current state of his health;

(b) offer to undertake a physical examination of the patient, comprising—

(i) the measurement of his blood pressure,

(ii) the taking of a urine sample and its analysis to identify the presence of albumin and glucose, and

(iii) the measurements necessary to detect any changes in his body mass index;

(c) record, in the records maintained in relation to the patient pursuant to paragraph 32, his findings arising out of the details supplied by or in relation to, and any examination of, the patient under this sub-paragraph;

(d) assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient; and

(e) in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, discuss with the patient (or, where the patient is a child, the appropriate person) the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

(3) In sub-paragraphs (2) and (4) and in paragraph 15(3)(e) “the appropriate person”, in relation to a child, is a person who has the right under regulation 39 to choose on behalf of the child the person by whom general medical services are to be provided for the child.

(4) On each occasion where a doctor invites a patient or, where the patient is a child, the appropriate person, to participate in a consultation pursuant to sub-paragraph (1), he shall—

(a) make the invitation in writing or, if the invitation is initially made orally, confirm it in writing, by a letter either handed to the patient or his representative or sent to the patient or, where the patient is a child, to the appropriate person, at the address recorded in the medical records kept for the patient as being his last home address or that of the appropriate person, as the case may be;

(b) record in the patient’s medical records the date of each such invitation and whether or not it was accepted;

(c) where, as a result of making the invitation, the doctor becomes aware that the patient is no longer residing at the address shown in his medical records, advise the Board accordingly.

(5) A doctor shall not be obliged to offer a consultation pursuant to sub-paragraph (1)—

(a) if he is a restricted services principal;

(b) in respect of a child under the age of 5 years;

(c) to any patient who, immediately before joining the list of a doctor, was a patient of a partner of the doctor and who, during the year immediately preceding the date of his acceptance or assignment to his current doctor’s list, had participated in a consultation pursuant to sub-paragraph (1); or

(d) to the extent allowed by the Board, to any patient within a class of patients in respect of which the Board or, on appeal, the Secretary of State, has pursuant to sub-paragraphs (6) to (9), deferred the doctor’s obligation under sub-paragraph (1).

(6) Where a doctor assumes responsibility for a list of patients on his succession to a vacant medical practice or otherwise becomes responsible for a significant number of new patients within a short period, he may apply, in accordance with sub-paragraph (7), to the Board for the deferment of his obligation under sub-paragraph (1) for a period not exceeding 2 years from the date of the application.

(7) An application pursuant to sub-paragraph (6) shall be made in writing and shall be accompanied by a statement of the doctor’s proposals by reference to particular classes of patients, with a view to securing that all eligible patients are invited to participate in a consultation pursuant to sub-paragraph (1) by the end of the period of the deferment.

(8) Within 60 days of receiving an application the Board shall decide it—

(a) by approving the application;

(b) by approving the application subject to conditions; or

and shall give written notice of its decision and, where it refuses the application or grants it subject to conditions, of its reasons for refusal or for such conditions, and of the doctor’s right of appeal under sub-paragraph (9).

(9) A doctor may appeal in writing to the Secretary of State against any refusal of an application, or against any condition subject to which an application is approved by a Board pursuant to sub-paragraph (8)(b), and on determining such an appeal the Secretary of State shall—

(a) either confirm the Board’s decision or substitute his own determination for the decision of the Board, and

(b) give to the doctor written notice of his decision and of his reasons therefor.

(10) In this paragraph and paragraph 15 “body mass index” means the figure produced by dividing the number of kilograms in the patient’s weight by the square of the number of metres in his height.

Patients not seen within 3 years

15

(1) Subject to sub-paragraph (2), where a patient who—

(a) has attained the age of 16 years but has not attained the age of 75 years; and

(b) within the preceding 3 years has attended neither a consultation with, nor a clinic provided by, any doctor in the course of his provision of general medical services, requests a consultation for the purposes of assessing whether he needs personal medical services, a doctor shall, in addition to and without prejudice to any other obligation under these terms of service, provide such a consultation.

(2) Sub-paragraph (1) shall not apply in the case of a doctor who is a restricted services principal.

(3) Where a doctor provides a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) where appropriate seek details from the patient as to the medical history of the patient, and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i) illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer,

(ii) social factors (including employment or unemployment, housing and family circumstances) which may affect his health,

(iii) factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol, and misuse of drugs or solvents) which may affect his health, and

(iv) the current state of his health;

(b) offer to undertake a physical examination of the patient, comprising—

(i) the measurement of his blood pressure,

(ii) the taking of a urine sample and its analysis to identify the presence of albumin and glucose, and (iii)the measurements necessary to detect any changes in his body mass index;

(c) record, in the records maintained in relation to the patient pursuant to paragraph 32, his findings arising out of the details supplied by or in relation to, and any examination of, the patient under this sub-paragraph;

(d) assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient; and

(e) in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, discuss with the patient (or, where the patient is a child, the appropriate person) the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

Patients aged 75 years and over

16

(1) Subject to sub-paragraph (2), a doctor shall, without prejudice and in addition to any other obligations under the terms of service, in each year beginning on 1st April—

(a) invite each patient on his list who has attained the age of 75 years to participate in a consultation, and

(b) offer to make a domiciliary visit to each such patient,

for the purpose of assessing whether he needs to render personal medical services to such a patient.

(2) Sub-paragraph (1) shall not apply in the case of any doctor who is a restricted services principal.

(3) Any consultation pursuant to sub-paragraph (1) may take place in the course of a domiciliary visit made pursuant to sub-paragraph (1).

(4) In the case of a patient who is accepted by a doctor pursuant to paragraph 6, or assigned to him pursuant to regulation 20 and who has attained the age of 75 years when he is so accepted or assigned, an invitation and an offer pursuant to sub-paragraph (1) shall be made within a year of the date of his acceptance or assignment.

(5) A doctor shall, when making an assessment following a consultation under sub-paragraph (1), record in the patient’s medical records kept pursuant to paragraph 32 his observations made of any matter which appears to him to be affecting the patient’s general health, including where appropriate, the patient's—

(a) sensory functions,

(b) mobility,

(d) physical condition, including continence,

(e) social environment, and

(f) use of medicines.

(6) A doctor shall keep with the patient’s medical records a report of any observations made in the course of a domiciliary visit made pursuant to sub-paragraph (1) which are relevant to the patient’s general health.

(7) When inviting a patient to participate in a consultation or offering him a domiciliary visit, pursuant to sub-paragraph (1), a doctor shall comply with the requirements of paragraph 14(4), as if that sub-paragraph referred to an offer as well as to an invitation.

(8) Where a patient has participated in a consultation pursuant to sub-paragraph (1), the doctor shall offer to discuss with him the conclusions he has drawn, as a result of the consultation, as to the state of the patient’s health, unless to do so would, in the opinion of the doctor, be likely to cause serious harm to the physical or mental health of the patient.

Absences, deputies, assistants and partners

17

(1) Subject to sub-paragraph (2) a doctor is responsible for ensuring the provision to each of his patients of the services referred to in paragraph 11 throughout each day during which his name is included in the medical list.

(2) A doctor who was, prior to 1st April 1990, relieved by the Board of such responsibility in respect of his patients during times approved by the Board may continue to enjoy such relief for so long as his name is included in the medical list.

18

(1) Subject to the provisions of sub-paragraphs (2), (3) and (4) a doctor shall give treatment personally.

(2) If reasonable steps are taken to ensure continuity of treatment the practitioner shall be under no obligation to give treatment personally to a patient and such treatment may be given—

(a) by a partner or assistant;

(b) by a deputy; or

(c) if it is treatment which it is reasonable in the circumstances to delegate to a person who is competent to carry out such treatment, by such person.

(3) In the case of child health surveillance services a doctor who has, pursuant to regulation 29(3), undertaken to provide such services may employ for the purposes of providing such services a deputy, associate or assistant general practitioner whose name is included in a child health surveillance list or, with the consent of the Board, some other deputy or assistant.

(4) In the case of minor surgery services a doctor who has, pursuant to regulation 33(2), undertaken to provide such services may employ a deputy, associate or assistant whose name is included in a minor surgery list to conduct a procedure described in Schedule 4.

(5) Without prejudice to paragraph 17(1), in relation to his obligations under these terms of service, a doctor is responsible for all acts and omissions of any doctor acting as his deputy, whether or not he is a partner or assistant, or of any deputising service, while acting on his behalf, or of any person employed by, or acting on behalf of, him or such a deputy or deputising service; but a doctor shall not be responsible for any act or omission for which a deputy is responsible under sub-paragraph (6).

(6) Where a doctor whose name is included in the medical list of any Board or of a Family Health Services Authority established under section 10(1) of the National Health Service Act 1977[^f00025] is acting as deputy to another doctor whose name is included in the medical list of a Board the deputy alone is responsible for—

(a) his own acts and omissions in relation to the obligations under these terms of service of the doctor for whom he acts as deputy; and

(b) the acts and omissions of any person employed by him or acting on his behalf.

(7) A doctor shall make all necessary arrangements for the treatment of his patients. He shall inform the Board of any standing deputising arrangements. When he proposes to be absent from his practice for more than 14 days he shall inform the Board of the arrangements he has made for the provision of general medical services to his patients during his absence. If he has undertaken the provision of contraceptive services or maternity medical services he shall ensure that the doctor or doctors providing general medical services on his behalf will also provide such services.

(8) Where such absence is to exceed 90 days he shall before the expiry of that period obtain the consent of the Board to such arrangement in respect of any period beyond the 90th day of his absence. In giving consent the Board may also impose such conditions as it thinks necessary or expedient to ensure the adequacy of such arrangements.

(9) The provisions of paragraph 19(8) and (9) shall apply with respect to the Board’s consent and conditions under sub-paragraph (8) as they apply under paragraph 19.

(10) A doctor shall not except with the consent of the Board employ any one or more assistants for a total period of more than 90 days in any period of 1 year and where such consent has been given it shall be subject to periodic review and may be withdrawn by the Board. Where the Board refuses or withdraws its consent the doctor may appeal against such refusal or withdrawal to the Medical Practices Committee by sending to the Committee notice of appeal within 14 days or such longer period as the Committee may allow from the date on which the Board notifies the doctor of its decision, and the Committee after such inquiry as it may think necessary shall determine the appeal.

(11) A doctor shall notify the Board as soon as possible of the name of any assistant he employs and of the termination of such employment.

(12) A doctor shall not, without the consent of the Secretary of State, employ as a deputy or assistant any doctor who is disqualified for inclusion in the medical list of the Board under section 29 of the Act[^f00026].

(13) A doctor acting as a deputy shall be entitled to treat patients at places and at times other than those arranged by the doctor for whom he is acting, due regard being had to the convenience of the patients.

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